Plné znění - 241/2006 Sb.

Questionnaire xxx xxx Assessment xx Xxxxxxxxxxxx xxx xxx Provision of Xxxxxxxxx Xxxxxxx xx Xxxxxxx xx Xxxxxxxx Xxxx pursuant xx Xxx No. 209/1997 Xxxx., xx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx to the xxxxxxx of xxxxxxxx xxxx xxx xx xxxxxxxx xxxxxxx xxxxx xxxx, xx amended

Dear Xxx/Xxxxx,

Xx xxxxxxxxx xxx xxxxxxxxx xxx xxxx xxxxxxxx xxxxxxxxx xx xxxx xxxxxxx xxxxxxxxx. Xxxxxxx, xxxxxxx in xxxx questionnaire xx xxxxxxxx for xxx xxxxx xxxxxxxxxx of xxxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx xx. 209/1997. Thank xxx xxx xxxx cooperation; xx xx xxxxxx xxxxxxxxxxx.

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X. Please legibly xxxx xx the xxxxxxxx xxxx xx xxx xxxxxxxxx - x.x. the victim xx xxx xxxxxxxx xxx xxx xxx xxxxxxxx xxxxxx xxxx, xx xxx xxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx act:

1. Xxxxxxx:

2. Given xxxx:

3. Xxxx xx birth:

4. Xxxxxxxxx xxxxxxx:

5. Xxxx xxxxxxxx address (xxxxxx xx xxxxxx xxxx xxx xxxxxxxxx address, xxxx):

6. Xxxxx Xxxxxx:

7. X-xxxx xxxxxxx:

8. Xxxxxxxxxxx:

XX. Xx the xxxxxxxxx xx xxxxxxxxxxx xx xxxxxxx xxxxxx ("xxxxxxxxxxxxxx") xx the basis xx xxxxxxxxx xxxxxxxxxxxxxx (xxx xxxxxxxx, x xxxxx child represented xx xxx/xxx parent) xx xx xxx xxxxx of x xxxxx xx attorney, xxxxxx fill in xxx data xx xxxx representative:

1. Xxxxxxx:

2. Xxxxx name:

3. Xxxxxxxxx xx xxxxxxxxxx xxxxxxx:

Xx xxx xxxxxxxxxxxxxx xx xxxxxx the xxxxxxxxxxx xx behalf of xxx applicant, please xxxx submit x xxxxxxxx authorizing him/her xx xxxxxxxxx the xxxxxxxxx - a xxxx of a xxxxx xx attorney (xxx contractual xxxxxxxxxxxxxx) xx x xxxx xx xxx birth xxxxxxxxxxx (xxx statutory xxxxxxxxxxxxxx) xx xxx xxxxx xxxxxxxxxx xxxxxxxx.

XXX. Xx xxx xxxxxxxxx xx x survivor xx a person xxx has died xx consequenee of xxx xxxxxxxxxx criminal xxx, xxxxxx fill xx the personal xxxx xx xxx xxxxxxxx:

1. Xxxxxxx:

2. Xxxxx xxxx:

3. Date xx xxxxx:

4. Xxxx of xxxxx:

5. Last xxxxxxxxx xxxxxxx:

6. Nationality:

7. Xxxxxxxxxxxx xx the deceased xx xxx xxxxxxxxx (x.x. father, xxxxxxxx, xx xxxxxxxxxx xxxxxx xx xxxxxx xxxxxxxxx)

Xx xxx applicant is x xxxxxxxx xx x person who xxxx xx xxxxxxxxxxx xx the xxxxxxxx xxx, please xxxxxx x copy of xxx xxxxx xxxxxxxxxxx xxx any xxxxxxxxx xxxxxxx that xxx xxxxxxxx xxxxxxxxx xx xxx xx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxx (xx the xxxx xx x xxxxxx-xxxxx relationship, xxxx xxxxxxxxx include xxxxx xxxxxxxxxxxx xx a xxxxx xxxxxxxx xx xxx xxxxxxxxxx xx xxxxxxx xxx xxxxxxxxx; xx xxx xxxx xx xxxxxxx couples, xxxxxx attach x xxxxxxxx xxxxxxxxxxx).

Xxxxxx xxxxxxx the xxxx xx xxxxx xxx xxxxx xxx xxxxxxxxx xxx, xx xxx xxxxxx learned xxxxx xxx consequences xx the xxxxx xx x xxxxx xxxx, xxxxxx also xxxxxxx the xxxx xxx xxx manner xx which xxx xxxxxx xxxxxxx xx xxxx consequences (e.g., xxx xxxx xx xxx xxxxxxx xxxxxx).

XX. Xxxxxx specify xxx xxxxxxxx xxxxxxx xxxxxxxxx (x.x. police, public xxxxxxxxxx'x xxxxxx, court) xxxxx xxxx xxxxxxxx xxxxxxxxx xxxxxxxx proceedings. Xxxxx xxx reference xxxxxx of xxx xxxx xxxxxxx xx xxx xxxxxxxxxx xxxxxxxxxxx.

Xx xxxxxxxxx, xxxxxx xxxxxx xxx latest xxxxxxxx xx xxx xxxxxxxxxxxxxx xxxxxxxx justice authority xxxxx could indicate xxx xxxxx xx xxx respective xxxxxxxxxxx (x.x. xxxxxxxxxx on xxx discontinuation xx xxxxxxxx xxxxxxxxxxx, xxxx xx xxx xxxxxxxxxx, xxxxxxxxx - final xx otherwise).

Xxxxxxxxx xx xxx provisions xx §8 of Xxx xx. 209/1997, xxx xxxxxx xx xxxxxxxxx support xxx xx xxxxxxx xx xxxxxxxx xxxxxxxxx xx xxxxxxx xxx xxxxxx xxx xxxx use xx all xxxxx xxxxxxxx to xxxxxxx x claim xxx xxxxxxxxxxxx xxxxxxx the xxxxxxxx xx xxx xxxxx xxxxxx xxxxxxxxxxx xxx the xxxx xxxxxxxx. Do not xxxx xx xxxx xxxx xx xxx xxxxxxxx has xxx xxxx identified.

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Fill xx xxxx XxXx xx xxx xxxxxxxxx is x xxxxxxxx xx xx xxxxxxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx the xxxxxxxxx crime.

1. Xxx xxx a xxxxx, xxxxxx xx xxxxx xx the xxxxxx xxx xxxx xx xxxxxxxxxxx xx xxx xxxxxxxx xxxxxxx?

2. Xxx xxx xxxx xx x common xxxxxxxxx xxxx the xxxxxxxx xxxxxx prior xx xxx xxxxxxxxxx xx xxx xxxxx?

3. Xxxx you x xxxxxxxxx of xxx xxxxxx xx xxx xxx xxxxxxxx xxxxxxx xx support xxx?

4. Xx xxx other xxxxxxx meet xxx xxxxxxxxxx xxxxxxxxx xx xxxxxxx 1 xx 3? Please xxxx xxxxx xxxxxx, xx xxxxx xx you.

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According xx xxx xxxxxxxxxx xx §2, section 2 xx Act xx. 209/1997, x xxxxxx xxx is x xxxxxxxx xx x xxxxxx xxx xxxx in consequence xx x xxxxxxxx xxx xx xxxxxxxxxx xx xx x xxxxxx xx xx xx she is x parent, spouse xx child xx xxx xxxxxxxx and xxxxx xxxx xxx xx her xx xxx xxxx xxxxxxxxx xx if the xxxxxx xxx x xxxxxxxxx xx the xxxxxxxx xx the xxxxxxxx was required xx xxxxxxx xxx xxxxxx.

Xx xxx xxxxxxxxx xx xxx victim xx x xxxxx xxx xxx suffered xxxxxx xxxx, please xxxx xx xxxxx XX - XIV.

Xxxxxx xxxxxx x xxxxx-xxxxx assessment xx xxxx xxx xxxxxxxxx pursuant xx Xxxxxx Xx. 440/2001 Xxxx. The respective xxxxxxxx should xx xxxxxxxx xxxx xxx xxxxxxxxx responsible xxx xxx xxxxxx'x treatment. Xxxx medical xxxxxx xxxx xxxxxxx x xxxxx-xxxxx xxxxxxxxxx of xxx xxx suffered xxx a xxxxx-xxxxx xxxxxxxxxx xx xxx xxxxxxxx xx xxx xxxxxx'x xxxxxx position. Xxxxxx xxxx in xxxx xxxx xxxx xxx point-based xxxxxxxxxx xx xxx xxx xxxxxxxx xx xxxxxxxx xxx xxx xxxxxxxx xx Xxx xx. 209/1997. According xx xxx provisions xx §6, xxxxxxx 2 xx Xxx xx. 209/1997, xx financial xxxxxxx xxxx xx xxxxxxxx unless the xxxxx xxxxxxxxxx xx xxx pain xxxxxxxx xx xx least 100 xxxxxx.

Xxx xxxxxx may obtain xxxx sum xxxxxxxxx xxxxxxx xx xxx xxxxxx xx CZK 25,000 or an xxxxxx xxxxx xx xxx xxxxxx xxxxx xx xxxxxxx treatment xxx xxxx xxxxxx (§7, section 1, xxxxxx x of Xxx Xx. 209/1997 Xxxx.). xx xxx xxxxxx xx xxxxx xxx x xxxx xxx xxxxxxx, xxxxx xx xx need xx xxxx xx xxxxx XII - XxX.

Xxxx includes xxx expenses for xxxxxxxxxx, xxxxxxxx xxxxxxxxx, xxxxxxxxxxxxxx xxxxx, xxxxxx xx assistant xx xxxx xxx in xxx xxxx or xxxx xxxxxxx xxxxxxxxx, xxxxxxxxx transportation costs xxx., xxxxxxxx xxxx xxxxx have xxx xxxx xxxx xx xx xxxxxxxxx xxxxxxx. xx such xxxxxxxx xxx xxx xxxxxx xx xxxxxxxxxxx xxxxxxxx, xxx Xxxxxxxx of Xxxxxxx may xxx xxxx xxxx xxxx xxxxxxxxxxxxx.

Xxxxxx xxxxxx xxx documents xxxxxxxxxx xxxx xxxxx xx xxx application.

If xxx xxxxxxxxx xx an xxxxxxxx, these xxxxxxxxx xxxxx include x xxxxxxxxx from xxx/xxx xxxxxxxx xxxxxxxxxx xxx xxxxxxx salary xxxxxxxxx xx §351 xx. xxx. of Xxx xx. 262/2006, xxx Xxxxx Labour Xxxx, xx xxxxxxx. xx xxx xxxxxxxxx xx xxxx-xxxxxxxx, such document xxxxx xx a xxxx of xxx/xxx xxxx xxxxxx xxx xxxxxx. lf the xxxxxxxxx xx x xxxxxxx xxxxxx xxx xx xxxx xx xxxxx his/her xxxxxxxx xxxxxx xxxxxxxx, please xxxxxx x document xxxxxxxxxx xxx amount xx the xxxxxxxxxx xxxxxxx. xx for xxx xxxxxx xxx xxxxxxxxx'x income situation xxxxxx be xxxxxx, xx xxxxxxxxxxx xxxxx xx affidavit xxx xx xxxxxxxx.

Xx xxxxxx xxxxxxxx has xxxx impaired as x result of xxx criminal xxx xx which X xxx x xxxxxx. X xxxx xxx xxx xxxx xxxxxxxxxxx xxx the harm 1 xxxx xxxxxxxx xx a result xx the xxxxxxxx xxx.

X xxxxxx xxxxxx xxxx I xxxx xxx xxxxxx xxx xxxxx xxx xxxxxxxxx xxxxxxx or xxx xxxxxxx xxxxx xxx xxxxxxxxxxxx xxx xxx xxxx xxxxxxxx as x result xx xxx xxxxxxxx xxx xx xxx country xxxxx xxxx the Xxxxx Xxxxxxxx.

X acknowledge xxxx according xx §12 of Xxx Xx. 209/1997 Xxxx., xx the provision xx financial support xxx xxx victims xx xxxxxxxx xxxx xxx on amending xxxxxxx other xxxx, xx xxxxxxx, X xx xxxxxxx xx xxxxxxxxx xxx Xxxxxxxx xx Justice any xxxxxx received xx xxxxxxxxxxxx for xxx xxxx xxxxxxxx, xx xx the amount xx the financial xxxxxxx, within xxxx xxxxx xxxx the xxxx xx xxxxxxxxx xxx xxxxxxx support. X xxxx xxxxxxxxxxx xxxx, after xxx xxxxx xx xxx xxxx-xxxx xxxxxx, X xxx xxxx xx xxxxxxxxxxx xxxxxx the Xxxxxxxx of Justice xx waive xxx xxxxx'x xxxxx xxx xxx xxxxxx of xxx xxxxxxxx xxxxxxx, xxxxxx xxxx a xxxxxx be xxxx xxxxxxxx by my xxxxxx xxxxxxxx, the xxxxx xxxxxx of xxxx suffered xxx xxx xxxxxx xx xxxxxxxxxxxx xxxxxxxx.

X xxxx xxxxxxxxxxx xxxx xxxxxxxxxxx xxxxxx xxxxx or xxxxxxxxxx information xx xxxxxxxxxxx information xxx xxx purposes xx xxxxxxxxxxxxx xxxxxxx xxxxxxxx xxx represent xx xxxxxxx xxxxxxxx xx §21, xxxxxxx 1, xxxxxx x) xx Xxx xx. 200/1990 Xxxx., xx xxxxxxxx xx xxxxxxx.

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Xxxxxxxxx xx xxx xxxxxxxxx xx xxx/xxx representative

- Xxxx xxxxxxx xx xxx xxxxxxxxxxx xxx xxx xxxxxxxxx xx xxxxxxxxx xxxxxxx xxxxxxxx xx Xxx Xx. 209/1997, xxx Xxxxxxxx xx Xxxxxxx xxxxx xxxxxxx xxxxxxx and assign xx x xxxxxx xxxxxx. Xxxxxxxxxxxx, xxx Xxxxxxxx shall xxxxxxxx xx xxxxxxxxxxxxx xxxx xxx police or x xxxxxxx xxxxxxxxx xx xxx the xxxxxxxx xxxxxxx of xxx case. Within xxxxx xxxxxx from xxx xxxx of xxx receipt xx xxx application xxx xxxxxxxxxx xx the xxxxxxxxx documents, xxx Xxxxxxxx xxxxx either xxxxxxx the xxxxxxx xx inform xxx xxxxxxxxx xx xxx xxxxxxx why such xxxxxxx xxx xxxx xxxxxxxx.

- Xxx applicant xxxxx xx xxxxxxxxxx x xxxxxx xx xxx Act Xx. 209/1997 Xxxx. only xx xx/xxx xxx xxxxxxxx bodily xxxx xx x xxxxxx xx the xxxxxxxxxx xx x xxxxx. X xxxxxxxxx but xxx xxx xxxx xxxxxxxxx for xxx xxxxxx'x xxxxxxx xx xxxxxxxx support shall xx xxx xxxxxx xx xxx xxxxx-xxxxx xxxxxxxxxx xx the xxx xxxxxxxx (xxx xxx xxxxxxxxx xx xxxxxx xxxxxxxx), xxxxx xxxx be xx xxxxx 100 points. Xxxxxxxxx xx x xxxxxx xxx xxx xxxx xx xxxxxxxxxxx xx a xxxxx xxxxx xx xxxxxxxxxx xx xx x xxxxxx if the xxxxxxxx xx a xxxxxx, xxxxxx xx xxxxx of xxx xxxxxxxx and the xxxxxxxx xxxxxx x xxxxxxxxx with the xxxxxxxx xx xxx xxxx xx his/her xxxxx xx xx xxx xxxxxxxx xxxxxxxxx xx xxx xxxxxxxx xx support the xxxxxxxx.

- Xxx Xx. 209/1997 Xxxx. xx xxx provision xx xxxxxxxxx xxxxxxx to xxxxxxx of xxxxxxxx xxxx xxxxxxxxxx a xxxxxxxxxx xxxx xx 1 year from xxx xxxx on xxxxx the victim xxxxxxx of the xxxx xxxxxx xx xxx crime. Xx xxxx xxxx does xxx xxxxxxxx xxxx xxx xxxx xx xxx xxxxxxxxxx xx xxx crime, xxx xxxxxx xxxxx provide xxxxxxxx of xxx xxxx xx xxxxx xx/xxx learned of xxx consequences. Xxx Xxxxxxxx xx Justice xxxxxx meet an xxxxxxxxxxx xxx xxx xxxxxxxxx xx financial xxxxxxx xxxxxxxx anytime xxxxx xxx xxxxx xx xxx xxxxxxxxxxxxxx xxxxxx.

- Xxxxxxxxx xxxxxxx xx applied xxx xx a xxxxxx xxx has xxxxxxxx xxxxxx harm xx x result xx xxx xxxxxxxxxx of x crime xxx xx xx xxx xxxx xx x xxxx xxx amounting xx XXX 25,000 xx an xxxxxx xxxxx xx xxxx xxxxxx xx xxx xxxxx xx xxxxxxx xxxxxxxxx xx proved xx the xxxxxx, xxxxxxx by any xxxxxx xxxxxxxxxx xxxx xx xxx xxxxxx xx xxxxxxxxxxxx xxx xxx harm xxxxxxxx. Xxx total amount xx xxxx support xxxx xxx xxxxxx XXX 150,000. If, xxxxx xxx xxxxxxxxx xx xxxxxxx, xxx xxxxxx xxxxxx xxxx xxx xxxx xxxxxxxx xxxxxxx xxx amount xxxxxxxx, xxx xxxxxx xxx receive xxxxxxxxxx xxxxxxx up xx xxx xxxxxx of XXX 150,000 if xx/xxx xxxxxxx xxx xx xxxxxx xxx xxxxxxxxxxxxxx period xx xxxx (x.x., 1 xxxx xxxx xxx xxxx xx xxxxx xxx victim xxxxxxx xx the xxxx xxxxxx xx xxx xxxxx); xx xxxx xxxx, xxx amounts xxxxxxx paid xxxx xx xxxxx into xxxxxxx.

- Xx xxxxxxxxxx xxx xx a xxxxxxxx of x xxxxxx who xxx xxxx xx x xxxxxx of xxx xxxxxxxxxx of x xxxxx (x parent, xxxxxx xx child xx the xxxxxxxx xxxxxx in a xxxxxx xxxxxxxxx xxxx xxx xxxxxxxx at xxx xxxx xx xxx/xxx xxxxx xx xxxxxxxxx xx xx xxxxxxxx to xx xxxxxxxxx xx xxx xxxxxxxx) xxxxx be xxxxxxxx xxxx a xxxx sum xxxxxxxxx xx XXX 150,000. Xxx xxxxx xxxxxx xxxxxxxx xx xxxxxxxxx xxxxxxx shall xxx xxxxxx XXX 450,000; xxxxxx the xxxxxx xx victims xxxxxx xxxxx, the xxxxxx xxxxxxxx xxx xxxxxx xxxxx xx xxxxxxx xxxxxxxxxxx.

- Xxx No. 209/1997 Xxxx. xxxx xxx replace the xxxxxxxxx xx xxx xxxxxxxxx xxxxxxxxx of xxxxxxxxx of xxxxx xxxxxxxx related xx xxxxxxxxxx xxxxxxxxx xxxxxxxxx. Xx xxxxxxx related xx traffic xxxxxxxxx, xxxxxxxxxxxx xxx xxxxxxxxx xxxxxxxx should xxxx xx xxxxxxxx xx xxx insurers xxxxxxxxx xxxx xxxxxxxxx xxxxxxxxx. Xxxx xx xxxxxxxx xxxxx, xx view xx xxxxxxxxxxx xxxxxxxxxxxxx, xxx xx xxxxxxxxxxx xxx the xxxxxxxxx xx financial xxxxxxx xx xxxxx xxxx xxx Ministry of Xxxxxxx.

- Please xxxx xx xxxx xxxx xxx available xxxxxxxxx xxx confirmations xxxxxxxx xxx xxx xxxxxxxxxx xxxxx xxxx xx xxxxxxxx xx xxx xxxxxxxxxxx. Xx the xxxxxxxxx fails xx xx so, xxx Xxxxxxxx xx Justice xxxxxx xxxxxxxx xxxxxxx xxx xxxxxxxxxxx. Should xxx applicant fail xx xxxxxxx xxx xxxx documents xxx xxxxxxxxxxxxx xxxx within x xxxxxxxxxxxxx xxxxxxxx, xxxx xxxx may xxxxxxx a decision xx withhold xxx xxxxxxx as xxx Xxx Xx. 209/1997 Xxxx. Xxxx shall xxx, xxxxxxx, xxxxxxxxx xxx filing xx xxxxxxx xxxxxxxxxxx.

- Please xxxx xx mind xxxx xxx xxxxxxxxx xxxxx be obliged xx xxxxxx any xxxxxxxxx amount xxxxxxxx xx xxxxxxxxxxxx for xxxx (xxxx xxx xxxxxxxx, xxxxxxxx etc.) xx the account xx xxx Xxxxxxxx xx Justice up xx xxx xxxxxx xx the xxxxxxx xxxxxxxx. Xxxx xxxxxxxxxx xxxx xxx xxxxx xx xx/xxx has xxx xxxxxxxx xxx xxxxxxxxxxxx. If xx xxxxxxxxx xx xxx xxxxxx in xx xxxxxxxxxxx, xxx Xxxxxxxx xx Xxxxxxx xxx xxxxx the state's xxxxx xx xxxxx xxx return xx xxx xxxxxxxxx support xxxxxxxx after xxx xxxxx of xxx xxxx-xxxx xxxx, xxxxxxxx xxxx x xxxxxx xx xxxxxxxxx by xxx xxxxxx'x xxxxxx xxxxxxxx, xxx total xxxxxx xx xxx xxxx xxxxxxxx and xxx amount xx xxxxxxxxxxxx xxxx xx xxx xxxxxx.

Xxxxxx pán/pani/slečna

Ospravedlňujeme xx, xx x xxxxxxxx, v xxxxxx xx xxxxxxxxxx, xxx xxxxxx Vás obťažovať xxxxxxxxxxxx xxxxxxxx. V xxxxxx xxxxxxxx xxxxxxxxx Xxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx trestnej činnosti xxxľx xxxxxx č. 209/1997 Zb., xx xxxx xxxxxxxxx xxxxx xxxxxxxxx nevyhnutné. Xxxxxxxx Xxx xx xxxxxxxxxx, ktorú xx xxxxx xxxxxx.

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X. Xxxxxx, xxxxxxx xxxxxxľxx osobné xxxxx x xxxxxxxľxxx - obeti xxxxxxxxx xxxx, xxxxxx xxôxxxxxx xxxx xx zdraví, xxxxx xxxxx xxxxxxxxxx xx xxxxx, ktorá x xôxxxxxx xxxxxxxxx xxxx xxxxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Xxxxxx trvalého xxxxxx:

5. Xxxxxxxxxxxxxx xxxxxx (x xxxxxxx, že xx xxxx xx xxxxxx xxxxxxxx bydliska):

6. Xxxxxxx:

7. X-Xxxx:

8. Občianstvo:

II. Ak xxxxxxxľx xxxxxxxxx xxx xxxxx (xxxxxxxx) na xxxxxxx zákonného zastúpenia (xxxx. xxxxxxxx xxxxx xxxxxx xxxxxxx) xxxxx xx xxxxxxx xxxxxx x xxxxx xxxx, xxxxxxx údaje o xxxxxxxxxx:

1. Priezvisko:

2. Meno:

3. Xxxxxxxxxxxxxx adresa:

Ak žiadate xx inú xxxxx, xxxx sa xxxxxxx xxxxxxxxxx, xxxxx xxxxxxxxxx xxxxxxx. Xxxxx x xxxxxxxx priložte xxxxx xxxxx moci (pri xxxxxxxx xxxxxxxxx) xxxxx xxxxx xxxxxxx listu (x prípade zákonného xxxxxxxxxx) xxxxx xxx xxxxxxx xxxxxxx.

XXX. Xx xxxxxxxľ alebo xxxxx xxxxxxxxx xx xxxxx, xxxxx x dôsledku xxxxxxxxx xxxx zomrela, xxxxxxx, prosím, xx xxxxx x umretej xxxxx:

1. Xxxxxxxxxx:

2. Xxxx:

3. Xxxxx xxxxxxxxx:

4. Dátum xxxxxx:

5. Posledné xxxxxxxx:

7. Xxxxxxxxxx:

8. X akom xxxxxx bola zomretá xxxxx v dôsledku xxxxxxxxx xxxx x xxxxx xxxxxxxľx (xxxx, xxxxx, xxxxx xxxxxx x xxxxxxxxx xxxxxxxxxx):

Xx xx xxxxxxxľ osobou xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, x xxxxxxxx xx xxxx priložiť xxxxx xxxxxxxx xxxxx x xxxxxxx, xxxxx xxxxxxxxx xxxxxxxxxx, xx umretá xxxxx xxxxxxxxxx xxxxxxxxx xxxxx alebo xxxx xxxxxxxxx xx xxxxxxxxx (xx xxxxxx xxxxx - xxxxx pôjde x xxxxx list xxxxx xxxxxxxxxxx súdu x xxxxxxxxxxx xxxxxxxxxx, xxx xxxxxxxx takou xxxxxxxx xxxx xxxxxxx xxxx x pod.)

IV. Xxxxxx, či xxxxxxx xxxxxxxx xxxxxxx pomoc xxxxxxxxxxxxxxx xxxxx alebo xxxxxxxx xx xxxxxxx xxxx; x xxxxx xxxxxxx xxxxxxx oznámte xxxxx Vášho účtu.

V. Xxxxxx xxxxx, xxxx xx xxxx xxxxxxxxx x xxxxx xxôxxxxxxx xxxxxxxx xxxxx.

Xxxxxx xxxxx xxxxxxxxx xxxxxxxxx činu x ak xx xxxx o škode xxx xxôxxxxxxx xxxxxxxxx xx neskôr, xxxxxx xxxx x xxx (xxxxxxxxx x xxxxxxxxx xxxxxx - dátum xxx xxxxxxxxxx).

XX. Xxxxxxx xxxxx činný v xxxxxxxx konaní (xxxxxxxxx xxxxx, štátne xxxxxxxxxxxxxx, xxx), xxxxx naposledy xxxxx konanie x xxxxxxxx xxxx. Xxxxxx xx xxxxxxx xxxxxx, xxx xxxxxx prebieha xxxxxxxxxxxx.

Xx xxxx k xxxxxxxxxx xxxxxxxx xxxxxxxxxxx xxxxxx xxxxxxx x xxxxxxxx xxxxxx, xxxxx xxxx predstavu o xxx, v xxxx xxxxxx xx xxx xxxxxxxx (xxxx. xxxxxxxxx x xxxxxxxx xxxxxxxxx xxxxxxxx, xxxx xxxxxxxx, xxxxxxxx - i xxxxxxxxxxxxx), pripojte ho x žiadosti.

VII. Uveďte, xxxx xxôxxxxx xxx xxxxxxxxx xxxxx xx xxxxxxx škody xx xxxxxxxľx xxxxx xxxx xxxxx, xxxxx zodpovedá xx xxxxx.

Xxxľx xxxxxxxxxxx §8 zákona č. 209/1997 (Xx)., xxxxxxxx xxxxx sa xôxx xxxxxx xxxxx xx xxxxxxxx x xxxxxxxxxxxxx xx to, či xxxx xxxxxxx všetky xxxxxxx prostriedky na xxxxxxxxxx nároku xx xxxxxxx xxxxx xx xxxxxxxľx alebo xxxx xxxxx, xxxxx zodpovedá xx škodu. Tento xxx nevyplňujte, xx xxxxxxxľx trestného xxxx xxxxxxxxx.

Xxx XXXX. Xxxxxxx, xx xxxxxxxľ je xxxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx činu zomrela.

VIII. Xxxxxx, xx ste xxxxxxx xxxxxx, xxxxx xxľxx podmienky uvedené x §2 odst. 2 xxxxxx č. 209/1997 Zb., xxxxxxxx xxľxx xxôx xxľxx xxxxx podmienky, xx xx Vám xxxxx xxxxxxxxxxx známe.

1. Xxxx xxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxx, xxxxx xxxxxxx x xôxxxxxx xxxxxxxxx činu?

2. Xxxx ste s xxxxxx xxxxxxxxx činu xxxx xxxxxxxxx xxxxxxxxx xxxx v spoločnej xxxxxxxxxx?

3. Poskytovala Vám xxxx xxxxxxxxx xxxx xxxxxx, či xxxx x tomu xxxxxxx?

4. Xxľxxxx xxxxx xxxxx xxxxxxxxxxx podmienky 1 xx 3? Uveďte xxx xxxxx, xx Xxx xx xxxxx.

Xxxľx xxxxxxxxxxx §2 xxxx. 2 xxxxxx x. 209/1997 Zb. xx xx obeť xxxxxxxx xxxxx xxxxxxxxx xx xxxxx, xxxxx x xôxxxxxx xxxxxxxxx xxxx xxxxxxx, ak je xxxxxxx, xxxxxxxx alebo xxxxxxxx xxxxxxxxx x xxxxxxx v xxxx xxxx xxxxx s xxx xxxx v xxxxxxxxxx alebo osoba, xxxxxx xxxxxx xxxxxxxxxx xxxxx bol xxxxxxx xxxxxxxxxx výživu.

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Body IX. xx XXX. Vyplňte, xx sa žiadateľ xxxx obeťou xxxxxxxxx xxxx a bola xx xxôxxxxxx ujma xx xxxxxx.

XX. Uveďte xxxxx, kedy sa xxxxxxxx liečenie, xxxxxxxxxx xxxx sa xxxxxxxx xxxxxxxx neschopnosť.

X. Celková xxxxx xxxxxxxx xxxxxxxxxxx xx bolesť xxxx:

X xxxxxxxx sa xxxx xxxxxxxx xxxxxx xxxxxxxxxxx xx bolesť xxxľx xxxxxxxx č. 440/2001 Zb., ktoré xxxxxxxľ xxxxx od xxxxxx, ktorý ho xxxxxxxxx. Tento lekársky xxxxxxx bude xxxxxxxxx xxxxxx hodnotenie xxxxxxxxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxxxxx xxxxxxxxxxxxx xxxxxxxxxx. Pripomíname, xx xxx účely xxxxxx č. 209/1997 Zb. je xxxxxxxxxx xxx bodové ohodnotenie xxxxxxxxx xxxxxxx. Xxxľx xxxxxxxxxxx §6 xxxx. 2 zákona x. 209/1997 Xx. xxxxxxx xxxxxxxxx' peňažnú xxxxx, xx bodové ohodnotenie xxxxxxxxx xxxxxxx xxxxxxxxxx xxxxxxxx 100 xxxxx.

XX. Xxxxxx, xx xxxxxxx x poskytnutie peňažnej xxxxxx xx xxxxx xxxxxxxxx čiastky 25 000.- Xx xxxxx xx xxxxxxxx výšku xxxxxx xxxxxxx a xxxxxxxx xx xxxxxxxx.

Xxxľx xxxxxxxxxxx §7 xxxx. 1 xxxx. x) xxxxxx x. 209/1997 Xx. xx žiadosť xxxxx xxxxx xxxxxxxxx peňažnú xxxxx xx výške xxxxxxxxx sumy 25 000.- Xx, xxxxx xx xxxxx xxxxxxxxxxxxxx xxxxxxxxxxx xxxxxxxx xx xxxxxxxx x xxxxxx xxxxxxx. Xx xx rozhodnete xxxxxx o xxxxxxx xxxxx xx výške xxxxxxxxx čiastky, xxxxxxxx xx xxxxxxxxx xxxx XXX. - XXX. xxxxx dotazníka.

XII. Xxxxxxx xxxxxxx x liečením xxxxxx:

Xxx x náklady xx xxxxx, xxxxxxxxxxxx xxxôxxx, náklady xx xxxxxxxxxxxxx, xxxxxxxxx xxxxxx xxxxx xx xxxxx x domácnosti xx xxxxxxxxxx, zvýšené náklady xx dopravu, a xxx. xxx podmienkou, xx xxxxx xxxxxxx xxxxxxxxx pojsťovňa. Tu xxxxxxx náklady xx xxxxx xxxxxxx, xxxx xx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxx xxxx xxxx xxxxxľ.

XXXX. Popište xxxxxxxxx xxxxxx xxxxxxxľx xxxx a xx xxxxxx ujmy xx xxxxxx spôsobenej xxxxxxxx xxxxx.

X žiadosti xxxxxxxx xxxxxxx, ktoré potvrdzujú xxxxxxx xxxxxxxxxxx.

X xxxxxxx, xx žiadateľ xx x xxxxxxxxxxxxxx pomere, xôxxx o xxxxxxxxxx xxxxxxxxxxxxľx x xxxxxxxxxx xxxxxxx podľa §351 x xxxx. xxxxxx x. 262/2006 Xx., xxxxxxxx xxxxx, v xxxxx xxxxxxxxxx xxxxxxxxx. Xx xx žiadateľ xxxxxx xxxxxxxxxx xxxxxxxxx xxxxxx, xxxxx xxxxxxxx xxxx napríklad opis xxxxxxxxxx xxxxxxxx xxxxxxxxx. Xx žiadateľ xxxxxx xxxxxxxx dôchodok, xxxxxxxx, xxxxx xôxx xxxxxxx xxxxxxxx sociálnu xxxxxxxx, xxxx potvrdenie o xxxxx xxxxxxxxxx xôxxxxxx. X xxxxxxx, že x xxxxxxxx xxxxxxxxx xôxxxx nemožno xxxxxxx xxxxxxxxx xxxxxx xxxxxxxľx, x krajnom xxxxxxx xx xxxxx nahradiť xxxxxxxxxx o nich xxxxxxx vyhlásením.

XIV. Uveďte xxxxx xxxxxxxxxxxx dávok (xxxxxxxxxxx xôxxxxxx) x xxxx, xxxxxx xxx xxxxxxxľ poberá, xx xxxxxxx xx vzniku xxxx xx zdraví, xxôxxxxxxx trestným činom.

K xxxxxxxx xxxxxxxx xxxxxxxxxx xxxxxxxxxxxxľx alebo xxxxxxxxx x výške nemocenských xxxxx. V xxxxxxx, xx x xôxxxxxx xxxxx xx zdraví xxôxxxxxxx trestným činom Xxx xxxxxxxx xxxxxxxxx xôxxxxxx, xxxxxx a xxxxxxx xxxx výšku.

Xxxx majetkové pomery xx xxxx, xx xxxxxxxx xxxxx, xxxxxxx xxx bol(a) xxxxxx, xx xxxx xxxxxxxx xxxxxxxx xxxxxxxx. Škodu, xxxxx mi takto xxôxxxxx, xxxxxľ nebola xxxxxxxx.

Xxxxxx xxxxxxxxxx, že xxxxx xx xxxxxxx xxxxx xx xxxxxxx xxxxx xx xxxxxxxxxxx xxxx xxôxxxxxxx xxxxxxxx xxxxx xxx xxxxxxxxxx(x) x žiadnom inom xxxxx ako x Xxxxxx (Xxxxxxxxxx) xxxxxxxxx.

Xxxxxx xx xxxxxxx, xx xx podľa ust. §12 xxxxxx x. 209/1997 Zb., o xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxx xxxxxxxx xxxxxxxx x x xxxxx x o xxxxxxxx xxxxxxxxxx xxxxxxx, x xxxxx xxxxxxxxxx predpisov, xxxxxx xxxxxxxxx do xxxxxxx xxxxx odo xxx, keď xx xxxxxxxx xxxxx, xxxxxxx xx účet Xxxxxxxxxxxx xxxxxxxxxxxxxx xxxxxxx, xxxxx xxx xxxxxx(x) xxx xxxxxxx xxxxx, x xx až xx xxxxx poskytnutej xxxxxx. Xxxxxxx x xxx xxxxxx xx vedomie, xx xx xxxxxxxx xxxxxxxxxx xäxxxxxxx doby xôxxx xxxxxxxx Xxxxxxxxxxxx xxxxxxxxxxxxxx, xxx sa x xxxx xxxxx xxxxxx xxxxx xx xxxxxxxx xxxxxxxxxxx xxxxxx, xx xxxx xxxxxxxx xxxxxxxx bude taký xxxxxx xxôxxxxxxxx, celková xxxxx xxxxx, ktorú xx xxôxxxxxx x xxxxx xxxxxxx, xxxxx xxx xxxxxx(x).

Xxxxxx xxxx xx xxxxxxx, že xxxxxxxxx xxxxxxxx nesprávneho xxxxx xxxxxxxxx xxxxx xx xxxx zatajením xx xxxxxx xxxxxxxx xxxxxxxxxxxx xxxxxx, xx xôxxx xxxxxxxx xxxxxxxxxx xxxľx §21 xxxx. 1 xxxx. x) xxxxxx x. 200/1990 Xx., x xxxxxxxxxxxx, x xxxxx neskorších xxxxxxxxx.

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xxxxxx xxxxxxxľx alebo xxxxxxxx

- Xxxxxxxxxxxx xxxxxxxxxxxxxx Xxxxx republiky xx xxxxxxx xxxxxxxx x xxxxxxxxxxx xxxxxxxx pomoci xxxľx xxxxxx č. 209/1997 Zb. xxxxxxx xxx príjem x xxxxx xxxxxxxx xxxxx. Potom xxxx xxxxxxxxxx xx xxxxxxx xx xx inom xxxxxxxx orgáne xxxľx xxxxxxxxxxx okolností xxxxxxx. Xx xxxxx mesiacov xx xxxxxx xxxxxxxx x predložení xxxxxxxxxx xxxxxxxx xxx pomoc xxxxxxxx xxxxx xxxxxxxľxxx xxxxxx dôvody, xxxxx xxxxx nemožno poskynúť.

- X xxxxxx xxxxxx č. 209/1997 Zb. xxxx xxxxxxxľ xxxxxxxxxx xx obeť xxx v xxxxxxx, xx mu x xôxxxxxx trestného xxxx xxxx xxôxxxxxx xxxxxxxxxx xxxxxxx. Xxxxxxxxxxx, xxx xxxx xxxxxxxxxxxx xxxxxxxxxx xx xxxxxxxxx peňažnej xxxxxx xxxxx xxxxx xx xxxxx xxxxxxxx xxxxxxxxxxx xxxxxxx (xxx xxxx sťaženie xxxxxxxxxxxxx xxxxxxxxxx) dosahujúceho xxxxx 100 bodov. Za xxxx xx xxxxxxxx xx osoba pozostalá xx obeti, ktorá x dôsledku xxxxxxxxx xxxx xxxxxxx, xx xxxx rodičom, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx x xxxxxxx v xxxx jeho smrti x xxx xxxx x xxxxxxxxxx, xxxxx xxxxx, ktorej zomretý xxxxxxxxxx xxxxx xxx xxxxxxx xxxxxxxxxx xxxxxx.

- Xxxxx č. 209/1997 Zb. o xxxxxxxxxx xxxxxxxxx pomoci xxxxxxx trestnej činnosti xxxxxxxxx xxxxxxxxxxx (xxxxxxxx) xxxx 1 xxxx xxx xxx, xxx xx xxxx xxxxxxxxx x škode xxôxxxxxxx xxxxxxxx xxxxx. Xx xxxxx xxxx už xxx xx xxx xxxxxxxxx trestného xxxx, xxxx dokazuje xxxxxxx, xxxx sa xx xxxxx. Ministerstvo xxxxxxxxxxxxxx xxxôxx xxxxxxxx žiadostiam x xxxxxxxxxxx peňažnej xxxxxx, ktoré xx xxxxxxxx xx uplynutí xxxxxxxxxx xxxxxx.

- Xxxxx xx xx xxxxxxx xxxxx, xxxxxx x xôxxxxxx xxxxxxxxx činu xxxxxxx škoda na xxxxxx, poskytne x xxxxxxxxx sume 25 000.- Xx xxxxx xx xxxxx, xxxxx xxxxxxxxxxx xxxxxxxxxx stratu xx xxxxxxx, preukázané náklady xxxxxxx x xxxxxxxx, xxxxxxx x xxxxx xxxxxxxx xxxxxxx, xxxxx xxxx x xxxxxx xxxxxxx škody xx xxxxxxx; xxxxx vo xxxxxx súčte nesmie xxxxxxxxxx xxxx 150&xxxx;000.- Xx. Xx obeť - po xxx, xxx jej poskytli xxxxx - preukáže, xx xxx xxxxxxxxx xxxxx je vyššia xxx tá, ktorá xxxx xxxxxxxxx xx xxxxxxxxxxx xxxxxx, xx xxx xxxxxxx x xxxxxx xxxxxxxxxx xxxxx xxxxxxx xxx xxxxx xxxxxxxxx xxxxx xxäx, x xx xx xx xxxxxxxxxx xxxxx 150&xxxx;000.- Xx; pričom xx xxxxxxxxxx xx xxxxxxx, ktoré už xxxx vyplatené.

- Xxxxxxxx xxxxx, ktorá xx xxxxxxxxxx po xxxxx, xxxxx v xôxxxxxx xxxxxxxxx xxxx xxxxxxx (xx xxxx xxxxxxx, xxxxxxxx xxxxx xxxxxxxx xxxxxxxxx a zároveň x xxxx xxxx xxxxx x xxx xxxx x xxxxxxxxxx, xxxxx jej xxxxxxx xxxxxxxxxx, xx xxx xxxxxxx xxxxxxxxxx výživu), xx xxxxxxxx peňažná xxxxx x xxxxxxxxx xxxx 150&xxxx;000.- Xx; xxxxx xx xxxxxx xxxxx xxxxxx xxxxxxxxxx xxxx 450 000.- Xx, x xx xx xxxxx xxxxx xxxx xxx xxx xxxxx, xxxxxxxxxxx xxxxxxx xx xxx xxxxxx xxxxx xxxxxxxxx kráti.

- Xxxxx č. 209/1997 Zb. nenahradzuje xxxxxxxx xxxxxxxxxxx xxxxxxxxxxxxx vykonávateľa xxxxxxxxxx xxxxxxxx, xx xxxxx nadväzuje povinné xxxxxxx xxxxxxxxx zodpovednosti. Xxxxx xx xxxxxxxx x xxxxxxxxxxxxxx xxxxxxxxxx xxxôx xxxxxx xxxxxxx, xxxxx spravuje poistenie xxxxxxxxxxxxx, x poskytnutie xxxxxxxxx xxxxxxx. Xxx x xxxxxx xxxxxxxxxxx xxxxxxxxx x prihliadnutím xx konkrétne výnimočné xxxxxxxxx je xxxxx xxxxxx xxxxxxxxxxxx spravodlivosti x xxxxxxxxxxx xxxxxxxx xxxxxx.

- Pripomíname, xx xx xxxxxxxxxx xxxxxxxx xxxxxx xxxxxxxx doklady x xxxxxxxxxx, xx xxxxx odkazujeme xxx xxxxxxxxxxxx xxxxxxxxx. Xx xxx žiadateľ xxxxxxx, xxxxxxxxxxxx xxxxxxxxxxxxxx xxxôxx xxxxxxx xxxxxxx. Ak xxxxxx xxxxxxxxxx x xxxxxxx ani xxxxxxxxx xxxxxx, xxxx skutočnosť xôxx xxx xôxxxxx xxxxxxxxxxxxx xxxxxxxx xxxxxx xxxľx xxxxxx č. 209/1997 Zb. Xx xxxx xxxxxxxxxx xxxxxxx podať xxxx xxxxxxx.

- Xxxxxxxxxxxx, xx xx xxxx xxxxxxxľxxx xxxxxxxxxx xxxxxxx xxxxx, xxxxxxxľ xx xx xxxxxxx xxxxx odo xxx poskytnutia xxxxxx xxxxxxx xx xxxx xxxxxxxxxxxx spravodlivosti xxxx, xxxxx dostal xxx xxxxxxx xxxxx (xx xxxxxxxľx, poisťovne a xxx.) xx do xxxxx poskytnutej pomoci. Xxxx xxxxxxxxx xxxx, xx xx xxxxx xxxxxxxxxx. Na xxxxxxx xxxxxxxx xxxxx xx xxxxxxxxxxxx xxxxxxxxxxxxxx xôxx x mene xxxxx xx xxxxxxxx stanovenej xäxxxxxxx doby xxxxx xxxxx na vrátenie xxxxxxxxxxx xxxxxxxx xxxxxx. Xx takýto xxxxxx xxôxxxxxxx xxxxxxxx xxxxxxxx xxxxx, xxxxxxx výška xxxxx, ktorú xxx xxôxxxxxx, x výška xxxxxxx, xxxxx xxxx xxxxxxx.